Opioid Use Across the Lifespan and Long Term Issues (Nursing)

by Prof. Lawes

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    00:01 Now opioids across the lifespan are particularly problematic.

    00:04 Elderly and infants are very sensitive to opioids so you want to use extra caution with these special populations.

    00:13 Now we took a second slide to make this point cuz remember neonates and infants have immature blood brain barriers so you have to use extreme caution when you’re considering the use of opioid in this particularly vulnerable and tiny population.

    00:29 Now here’s another grouping of who you want to avoid opioid use with.

    00:34 First of all, pregnancy or labor and delivery - wow, you're thinking like, man, that’s pretty painful, why wouldn’t we use opioids? Well, in labor and delivery opioids can suppress uterine contractions - that’s not a good idea, right? And it can also cause respiratory depression in the neonate, so that’s why we avoid opioids; we use other medications in labor and delivery.

    00:57 Head injuries, we just walk through that so see what you can pause and recall about head injuries.

    01:01 What are two reasons we would try to avoid opioid use in patients who suffered a head injury? Welcome back, let’s look at the third person.

    01:11 People who are respiratory compromised - they’re not on the ventilator, that mean supported; they’re not on the ventilator and their compromised respiratory-wise.

    01:20 They might have really bad lungs or severe COPD or asthma - you wanna be very careful with that because we know that opioids can cause respiratory depression.

    01:29 If they are already struggling in their respiratory status because of a disease process or an injury and we don’t have them on a ventilator, then we wanna be very careful with opioid use.

    01:39 Now of course opioids and alcohol or any other CNS suppressant is a bad idea - cannot stress that enough.

    01:47 Opioids and alcohol is a real risk for overdose and risking the patient’s death.

    01:53 Now there’s long term issues that are included with opioids, there's tolerance.

    01:58 Now they develop a tolerance to analgesia, euphoria, sedation and thankfully to respiratory depression, that’s one bit of a positive.

    02:06 You see the problem with taking opioids long term is that you need more and more and more to get pain relief that you need.

    02:14 Now even in an appropriate clinical setting I’m gonna look at the administration of an opioid to one patient who’s never had them, we call them naïve versus a patient who’s had multiple doses of opioids.

    02:28 The person who’s never had opioids before is gonna take a much smaller dose because they haven’t developed tolerance.

    02:35 The person who’s taken lots of opioid for appropriate reason is gonna have a tolerance to pain relief so they're gonna take much bigger doses in order to get that pain relief.

    02:45 Now, sadly, opioid tolerance never develops to constipation, that would be fantastic if it did.

    02:52 It also doesn’t to miosis but constipation is a really problem.

    02:56 So on special note, if I have a tolerance to one opioid agonist, I’ll have a cross-tolerance to another opioid agonist so if I've been on one opioid agonist, anyone of the examples that we’ve talked about and I’ve built up a tolerance to it, it doesn’t matter what opioid agonist you give me, I’ll still have a tolerance build up to that one, we call it a cross tolerance.

    03:19 Now physical dependence is the need for opioids in order to avoid the withdrawal symptoms, so my body is so used to getting these opioids it’s physically dependent on them.

    03:31 If I don’t have them I’m gonna go through these miserable withdrawal symptoms, so even if I've been on an appropriate prescription for as little as 20 days but it’s a pretty high dose, my body will develop physical dependence.

    03:44 That’s why it’s very important with opioids and all CNS medications not to just stop them abruptly.

    03:50 You wanna wean those opioids over a period of time, that means you'll gradually decrease the dosage and increase the length of time in-between doses so that you can avoid the withdrawal symptoms.

    About the Lecture

    The lecture Opioid Use Across the Lifespan and Long Term Issues (Nursing) by Prof. Lawes is from the course Central Nervous System (CNS) Medications (Nursing). It contains the following chapters:

    • Opioid Use across the Lifespan
    • Long Term Issues of Opioids

    Included Quiz Questions

    1. They have immature blood-brain barriers.
    2. They have immature lungs.
    3. They have immature livers.
    4. They have immature pain receptors.
    1. A client having elective spinal surgery
    2. A pregnant client in active labor
    3. A client in alcohol withdrawal who has anxiety and pain
    4. A client with COPD and respiratory distress
    1. Clients with a dependence need opioid medications to avoid withdrawal.
    2. Clients will have a similar response to other opioid medications.
    3. Clients will not develop constipation or miosis.
    4. Clients develop a dependence because they take their opioid in a different manner from how the medication was prescribed.

    Author of lecture Opioid Use Across the Lifespan and Long Term Issues (Nursing)

     Prof. Lawes

    Prof. Lawes

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